Complexity-based measures inform Tai Chi's impact on standing postural control in older adults with peripheral neuropathy

Abstract

Background: Tai Chi training enhances physical function and may reduce falls in older adults with and without balance disorders, yet its effect on postural control as quantified by the magnitude or speed of center-of-pressure (COP) excursions beneath the feet is less clear. We hypothesized that COP metrics derived from complex systems theory may better capture the multi-component stimulus that Tai Chi has on the postural control system, as compared with traditional COP measures.

Methods: We performed a secondary analysis of a pilot, non-controlled intervention study that examined the effects of Tai Chi on standing COP dynamics, plantar sensation, and physical function in 25 older adults with peripheral neuropathy. Tai Chi training was based on the Yang style and consisted of three, one-hour group sessions per week for 24 weeks. Standing postural control was assessed with a force platform at baseline, 6, 12, 18, and 24 weeks. The degree of COP complexity, as defined by the presence of fluctuations existing over multiple timescales, was calculated using multiscale entropy analysis. Traditional measures of COP speed and area were also calculated. Foot sole sensation, six-minute walk (6MW) and timed up-and-go (TUG) were also measured at each assessment.

Results: Traditional measures of postural control did not change from baseline. The COP complexity index (mean ± SD) increased from baseline (4.1 ± 0.5) to week 6 (4.5 ± 0.4), and from week 6 to week 24 (4.7 ± 0.4) (p=0.02). Increases in COP complexity-from baseline to week 24-correlated with improvements in foot sole sensation (p=0.01), the 6MW (p=0.001) and TUG (p=0.01).

Conclusions: Subjects of the Tai Chi program exhibited increased complexity of standing COP dynamics. These increases were associated with improved plantar sensation and physical function. Although more research is needed, results of this non-controlled pilot study suggest that complexity-based COP measures may inform the study of complex mind-body interventions, like Tai Chi, on postural control in those with peripheral neuropathy or other age-related balance disorders.

Figures

Figure 1

Standing postural control in older adults with peripheral neuropathy over the course of a 24 week Tai Chi training program. The Tai Chi training intervention was not associated in significant changes in center-of-pressure (COP) area (A) or speed (B). On the other hand, subjects demonstrated significant (p<0.05, arrows) increases in COP complexity (C) from baseline to week 6, and again from week 6 to week 24. Error bars reflect standard error from the mean.

Figure 2

Relationships between changes in foot sole sensation, center-of-pressure (COP) complexity, and physical function following 24 weeks of Tai Chi training in older adults with peripheral neuropathy. Improved foot sole sensation, defined as the change in the number of five tested foot sole sites on which the subject could perceive the 5.07 gauge monofilament, correlated with the percent change in the degree of COP complexity during quiet standing with closed eyes (A). The percent increase in COP complexity correlated with the percent decrease in the time needed to complete the timed up-and-go test (TUG) (B), and the percent increase in the distance covered in the 6 minute walk (6MW) test (C). The correlation between changes in traditional COP parameters (area and speed) and physical function (not pictured) were not significant.